1
|
Thangavelu K, Gillhausen F, Weiß RM, Mueller-Mazzotta J, Stuck BA, Reimann K. Role of prior intratympanic gentamicin and corticosteroids therapy on speech understanding in patients with Menière's disease after cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:3483-3490. [PMID: 38302621 PMCID: PMC11211197 DOI: 10.1007/s00405-024-08449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
AIM Intratympanic injection of corticosteroids (ITC) and gentamicin therapy (ITG) are widely used treatments for vertigo in Meniere's disease (MD). Even though studies show good results after cochlea implantation (CI) in MD patients when compared to non-MD groups, there is no indication on the effect of ITC and ITG prior to CI on hearing after CI. This study compares the post-operative hearing of CI patients with and without MD and patients who have received ITG or ITC prior to CI. METHODS In a retrospective case control study, adult patients with MD who received CI from 2002 till 2021 were compared to a matched control group of CI patients without MD. Patients with prior ITC/ITG were extracted from MD group. Pre-operative audiological results were measured and trends across post-operative monosyllabic word recognition score at 65 decibels (WRS65CI) at switch-on, 3-6 months, 1 year and last yearly value were analyzed across all groups. RESULTS 28 MD ears were compared with 33 control ears. From MD ears 9 had received ITG and 6 ITC prior to CI. WRS65CI increased significantly with time within MD and control groups, but no difference in WRS65CI was found between these 2 groups. ITG ears showed fluctuating WRS65CI after CI with no change across time, while ITC ears showed significant increase in trend of WRS65CI values across time. CONCLUSION MD and non-MD patients showed comparable hearing results after CI. Prior ITC might positively influence hearing preservation after CI in MD patients whereas ITG group showed fluctuating hearing.
Collapse
Affiliation(s)
- Kruthika Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Frederic Gillhausen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Rainer M Weiß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jochen Mueller-Mazzotta
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Katrin Reimann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| |
Collapse
|
2
|
Yılmaz Topçuoğlu MS, Plinkert PK, Praetorius M, Euteneuer S. Long-term outcome of patients with Ménière's disease following cochlear implantation: a comprehensive outcome study with validated assessment tools. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08690-1. [PMID: 38767697 DOI: 10.1007/s00405-024-08690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Patients suffering from Ménière's disease (MD) experience vertigo, and impairments in hearing and quality of life (QoL). This study aims to investigate the impact of cochlear implantation (CI) on various aspects affecting patients with MD. METHODS A single tertiary centre's CI database for CI recipients with MD between 2014 and 2022 was screened retrospectively. Hearing, vertigo, tinnitus symptoms, and hearing-related QoL were assessed. Pre- and postoperative hearing tests in conjunction with subjective outcome measures by visual analogue scale (VAS) and validated tools such as the Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI) and Nijmegen Cochlear Implant Questionnaire (NCIQ), as well as the assessment of the pre- and postoperative Functional Level Scale (FLS) were examined. RESULTS Eleven ears were included (median age: 59 years at implantation). Following implantation, there was a significant enhancement in Word Recognition Scores at sound levels of 65 dB and 80 dB compared to before treatment (preop vs. 12 months postop: p = 0.012). However, no significant enhancement was observed for 50 dB. MD-related impairments improved significantly postoperatively, as measured by the VAS (vertigo: p = 0.017; tinnitus: p = 0.042), DHI (p = 0.043), THI (p = 0.043) and NCIQ (p < 0.001). The FLS improved significantly (p = 0.020). CONCLUSION CI has positive effects on all areas examined in our cohort. However, discrimination of speech at low sound pressure levels remained problematic postoperatively. In patients suffering from MD, the prioritized treatment goals include not only improved hearing but also the rehabilitation of vertigo and tinnitus, as well as the enhancement of QoL. Validated instruments are useful screening tools.
Collapse
Affiliation(s)
- Miray-Su Yılmaz Topçuoğlu
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Peter K Plinkert
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Mark Praetorius
- Department of Otorhinolaryngology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Euteneuer
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
3
|
Czurda R, Wesarg T, Aschendorff A, Beck RL, Hocke T, Ketterer MC, Arndt S. Investigation of Maximum Monosyllabic Word Recognition as a Predictor of Speech Understanding with Cochlear Implant. J Clin Med 2024; 13:646. [PMID: 38337340 PMCID: PMC10856473 DOI: 10.3390/jcm13030646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The cochlear implant (CI) is an established treatment option for patients with inadequate speech understanding and insufficient aided scores. Nevertheless, reliable predictive models and specific therapy goals regarding achievable speech understanding are still lacking. Method: In this retrospective study, 601 cases of CI fittings between 2005 and 2021 at the University Medical Center Freiburg were analyzed. We investigated the preoperative unaided maximum word recognition score (mWRS) as a minimum predictor for post-interventional scores at 65 dB SPL, WRS65(CI). The WRS65(CI) was compared with the preoperative-aided WRS, and a previously published prediction model for the WRS65(CI) was reviewed. Furthermore, the effect of duration of hearing loss, duration of HA fitting, and etiology on WRS65(CI) were investigated. Results: In 95.5% of the cases, a significant improvement in word recognition was observed after CI. WRS65(CI) achieved or exceeded mWRS in 97% of cases. Etiology had a significant impact on WRS65(CI). The predicted score was missed by more than 20 percentage points in 12.8% of cases. Discussion: Our results confirmed the minimum prediction via mWRS. A more precise prediction of the expected WRS65(CI) is possible. The etiology of hearing loss should be considered in the indication and postoperative care to achieve optimal results.
Collapse
Affiliation(s)
- Ronja Czurda
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Thomas Wesarg
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Antje Aschendorff
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Rainer Linus Beck
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Thomas Hocke
- Cochlear Deutschland GmbH & Co., KG, Mailänder Straße 4 a, 30539 Hannover, Germany;
| | - Manuel Christoph Ketterer
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| | - Susan Arndt
- Department of Otorhinolaryngology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany; (T.W.); (A.A.); (R.L.B.); (M.C.K.); (S.A.)
| |
Collapse
|
4
|
Kanona H, Forde C, Van Rooyen AM, Keating P, Bradley J, Pendolino AL, Mehta N, Manjaly JG, Khalil S, Lavy J, Saeed SR, Shaida A. Cochlear implant outcomes in patients with Meniere's disease: a large case series. Cochlear Implants Int 2022; 23:339-346. [PMID: 36050279 DOI: 10.1080/14670100.2022.2112998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To perform a matched cohort study to assess whether patients with Meniere's Disease (MD) require more intensive auditory rehabilitation following cochlear implantation (CI) and identify factors that may affect outcomes in patients with MD. METHODS A retrospective case review was performed. MD and control patients were matched for age, biological sex, implant manufacturer and electrode design. Outcomes measured were speech scores, number of visits to audiology department following switch-on, and post-operative active MD. RESULTS Forty consecutive implanted MD patients were identified between May 1993 and May 2019. Patients with active MD following CI required significantly more visits to the audiology department compared to controls (P < 0.01) and patients who had inactive MD post-operatively (P < 0.01). However, in MD patients, active MD was less likely following CI (P = 0.03). In patients who continued to experience active MD post-operatively, further medical and surgical ablative intervention was required to control ongoing Meniere's attacks. CONCLUSION We present the largest case series of performance outcomes in CI patients with MD. Although speech outcomes in MD patients are comparable to controls, patients with active MD pre-operatively are more likely to experience variation in CI performance requiring a prolonged period of auditory rehabilitation compared to inactive preoperative MD.
Collapse
Affiliation(s)
- Hala Kanona
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Cillian Forde
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Anne M Van Rooyen
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | | | - Jane Bradley
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Alfonso Luca Pendolino
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Nishchay Mehta
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
| | - Joseph G Manjaly
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
- NIHR UCLH BRC Deafness and Hearing Problems Theme, Ear Institute, University College London, London, UK
| | - Sherif Khalil
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Jeremy Lavy
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Shakeel R Saeed
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
| | - Azhar Shaida
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| |
Collapse
|
5
|
Wrobel C, Bevis NF, Klinge‐Strahl A, Strenzke N, Beutner D. Performance and self-perceived hearing impairment after cochlear implantation in Menière's disease. Laryngoscope Investig Otolaryngol 2022; 7:219-225. [PMID: 35155801 PMCID: PMC8823173 DOI: 10.1002/lio2.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/16/2021] [Accepted: 11/27/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evaluation of the self-perceived hearing impairment and performance after cochlear implantation in patients with definite Menière's disease (MD). PATIENTS AND METHODS Seventeen unilaterally or bilaterally profoundly hearing-impaired patients suffering from MD who received a cochlear implantat (CI) were eligible for inclusion in this study. Their self-perceived hearing impairment using the short Speech Spatial and Qualities of Hearing Scale (SSQ12) as well as their performance in speech perception (German language Freiburger mono- and multisyllable test, Oldenburger sentence test) were compared with a best-matched control group of non-MD patients up to 24 months of follow-up. RESULTS MD patients improved significantly in perception of monosyllables presented at 65 dBSPL, from preoperatively best aided 18.2% [2.4, 34.0] to 51.7% [39.4, 63.9] 1 year after cochlear implantation (mean [95% confidence interval]). Their performance approached the matched controls with 63.2% [55.7, 70.8]. Monosyllables presented at a lower intensity of 55 dBSPL revealed a significant underperformance of the MD patients (21.1% [12.6, 29.6]) in contrast to the non-MD controls (39.1% [30.9, 47.4]) 12 months post-CI. Self-assessed hearing disability was significantly more pronounced in MD patients with a mean total SSQ12 score of 3.6 [2.4, 4.9] in comparison to 6.1 [5.4, 6.8] of the matched non-MD controls after 12 months of cochlear implantation. CONCLUSION Cochlear implantation substantially improves hearing capabilities in profoundly hearing-impaired patients with MD, but they tend to underperform in comparison to non-MD patients at least at lower sound pressure levels. This is likely one reason for the poorer self-assessed hearing function of cochlear implanted MD patients. LEVEL OF EVIDENCE 3, retrospective, nonrandomized follow-up study.
Collapse
Affiliation(s)
- Christian Wrobel
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Nicholas F. Bevis
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Astrid Klinge‐Strahl
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Nicola Strenzke
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| |
Collapse
|
6
|
Atturo F, Portanova G, Russo FY, Seta DD, Mariani L, Borel S, Greco A, Mosnier I, Mancini P. Cochlear implant in immune mediated inner ear diseases: Impedance variations and clinical outcomes. Cochlear Implants Int 2021; 23:70-79. [PMID: 34844527 DOI: 10.1080/14670100.2021.1992149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Immune-mediated inner ear disease (IMIED) might cause severe/profound hearing loss and these patients are considered ideal candidates to cochlear implant (CI) surgery. The aim of the study was to evaluate impedance changes over time. METHOD The Study Group (SG) was composed of CI IMIED patients (31 ears) and a Control Group (CG) of CI patients with hearing loss not related to their immune system (31 ears). Audiological performance and impedance values were measured and compared amongst groups at 3, 6, 12 and 18 months following the fitting sessions. RESULTS Speech perception was significantly better for SG in word and sentence recognition in quiet. Impedance values were, on average, significantly higher for apical and middle electrode segments in SG compared to CG at the 3- month follow-up and were maintained over time. Additionally, a subset of SG patients (active patients) experienced significantly greater impedance fluctuation corresponding to clinical symptom reactivation. CONCLUSION IMIED patients achieve good audiological performance. However, the relapsing inflammation could change the inner ear environment, causing impedance fluctuations and, consequently, more frequent CI fittings. Additionally, impedance evaluation could be utilized as an early warning sign of IMIED recurrence and as an aid to therapeutic decision-making.
Collapse
Affiliation(s)
- Francesca Atturo
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - Ginevra Portanova
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | | | - Daniele De Seta
- Unit of Otorhinolaryngology, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Laura Mariani
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - Stephanie Borel
- Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Antonio Greco
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - Isabelle Mosnier
- Service ORL, Otologie, Implants Auditifs et Chirurgie de la Base du Crâne, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Patrizia Mancini
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
7
|
Desiato VM, Patel JJ, Nguyen SA, Meyer TA, Lambert PR. Cochlear implantation in patients with Meniere's disease: A systematic review. World J Otorhinolaryngol Head Neck Surg 2021; 7:303-311. [PMID: 34632344 PMCID: PMC8486698 DOI: 10.1016/j.wjorl.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/09/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Meniere's disease (MD) is an idiopathic disorder of the inner ear, which manifests as cochleo-vestibular dysfunction. Hearing loss will progress to a profound levelin a subset of patients with MD, and vestibular interventions can independently cause loss of hearing. The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD. MATERIALS AND METHODS A systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI. Demographic information, disease history, MD symptoms, outcomes measures, and complications related to CI were extracted from included studies. RESULTS In total, 17 studies were included, and 182 patients with MD underwent CI. The weighted-mean age was 61.9 years (range 27-85). Study objective and methodology varied, and there was significant heterogeneity in CI outcome measures reported. In total, 179 (98.3%) of 182 patients reported objective improvements in at least one hearing metric after CI. A total of 69 patients (37.9%) reported vertigo or severe dizziness prior to CI, compared to 22 patients (15.4%) postoperatively. Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score (THI). Quality of life assessments varied between studies. Complications rates were low with only nine patients (4.9%) reporting a serious CI-related complication. CONCLUSIONS This systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes, and heterogeneity in study design and outcomes measured. Despite these limitations, this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD. The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.
Collapse
Affiliation(s)
- Vincent M. Desiato
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jaimin J. Patel
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A. Meyer
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul R. Lambert
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
8
|
Selleck AM, Dillon M, Perkins E, Brown KD. Cochlear Implantation in the Setting of Menière's Disease After Labyrinthectomy: A Meta-Analysis. Otol Neurotol 2021; 42:e973-e979. [PMID: 34049331 DOI: 10.1097/mao.0000000000003200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Characterize the speech recognition and sound source localization of patients with unilateral Menière's disease who undergo labyrinthectomy for vertigo control with simultaneous or sequential cochlear implantation. DATABASES REVIEWED PubMed, Embase, and Cochrane databases. METHODS The search was performed on May 6, 2020. The keywords utilized included: "Menière's disease AND cochlear implant;" "cochlear implant AND single sided deafness;" "cochlear implant AND vestibular;" and "labyrinthectomy AND cochlear implant." Manuscripts published in English with a publication date after 1995 that assessed adult subjects (≥18 years of age) were included for review. Subjects must have been diagnosed with Menière's disease unilaterally and underwent labyrinthectomy with simultaneous or sequential cochlear implantation. Reported outcomes with cochlear implant (CI) use included speech recognition as measured with the consonant-nucleus-consonant (CNC) word test and/or sound source localization reported in root-mean squared (RMS) error. The method of data collection and study type were recorded to assess level of evidence. Statistical analysis was performed with Wilcoxon signed ranks test. RESULTS Data from 14 CI recipients met the criteria for inclusion. Word recognition comparisons between the preoperative interval and a postactivation interval demonstrated a significant improvement with the CI (p = 0.014), with an average improvement of 23% (range -16 to 50%). Sound source localization postoperatively with the CI demonstrated an average RMS error of 26° (SD 6.8, range 18.7-43.1°) compared to the 42° (SD 19.1, range 18-85°) in the preoperative or CI off condition, these two conditions were not statistically different (p = 0.148). CONCLUSION Cochlear implantation and labyrinthectomy in adult patients with Menière's disease can support improvements in speech recognition and sound source localization for some CI users, though observed performance may be poorer than traditional CI candidates.
Collapse
Affiliation(s)
- Anne Morgan Selleck
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| | - Margaret Dillon
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| | - Elizabeth Perkins
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin D Brown
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina
| |
Collapse
|
9
|
Chien CY, Kulthaveesup A, Herrmann BS, Rauch SD. Cochlear Implantation Hearing Outcome in Ménière's Disease. Otolaryngol Head Neck Surg 2021; 166:523-529. [PMID: 34003698 DOI: 10.1177/01945998211012298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the hearing outcome of cochlear implantation in patients deafened by Ménière's disease. STUDY DESIGN Retrospective single-institution study. SETTING Tertiary medical center. METHODS Our institutional database of 1400 patients with cochlear implants was reviewed to identify cases with deafness due to Ménière's disease. Twenty-nine patients were identified: 24 with unilateral and 5 with sequential bilateral cochlear implants. Pre- and postoperative speech recognition scores and medical data were extracted from the medical record and analyzed. RESULTS Overall the mean difference between pre- and postoperative speech recognition after >1 year was 56% (95% CI, 47.08%-64.92%). The mean preoperative monosyllabic word score was 9.5%, and the mean postoperative scores at 1 month, 3 months, 6 months, 1 year, and >1 year were 37.1%, 46.1%, 54.1%, 59.1%, and 66.8%, respectively. Cochlear implantation resulted in improved word scores in all patients regardless of prior medical or surgical treatment (endolymphatic sac, labyrinthectomy). The mean postoperative hearing improvement in patients aged <70 and ≥70 years was 65.26% (95% CI, 54.79%-75.73%) and 40.00% (95% CI, 27.22%-52.77%). Postoperative word scores in patients with bilateral cochlear implants were not significantly different between the first and second implanted ears or between the monoaural and binaural testing conditions. CONCLUSION Cochlear implant in patients deafened by Ménière's disease significantly improves word recognition scores regardless of whether medical or surgical treatment is used prior to implantation. The potential improvement in word recognition scores decreases after age 70 years.
Collapse
Affiliation(s)
- Chen-Yu Chien
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otorhinolaryngology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City
| | - Anan Kulthaveesup
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Barbara S Herrmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Steven D Rauch
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Cochlear Implantation in Patients With Menière's Disease: Does Disease Activity Affect the Outcome? Otol Neurotol 2021; 41:1296-1304. [PMID: 32925864 DOI: 10.1097/mao.0000000000002750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Menière's disease (MD) is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of bilateral deafness due to MD alone or contralateral pathology, cochlear implantation (CI) improves hearing. Active MD is characterized by fluctuating auditory symptoms and vertigo; whereas remittance of vertiginous symptoms and severe, permanent sensorineural hearing loss characterizes the inactive disease state. This study evaluates outcomes for MD patients compared with the general CI population and assesses if disease activity affects implant outcomes. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Twenty-four patients with MD that received CI (7 active, 16 inactive, and 1 Probable Menière's), and 24 age-matched controls. INTERVENTIONS Cochlear implantation. MAIN OUTCOME MEASURES Word Recognition Score, Sentence Recognition Score (SRS), and Speech Reception Threshold. RESULTS Best-aided preoperative and postoperative audiometric data were compared per ear between MD patients and controls and stratified by disease status using descriptive statistics with mixed-effects modeling. Patients with MD derived significantly more benefit from CI than controls when comparing differences between preoperative and postoperative levels for Word Recognition Score (12.2%, p = 0.0236), SRS (12.8%, p = 0.0375), and Speech Reception Threshold (-14.4 dB, p = 0.0188). Active disease status does not negatively impact CI outcomes and patients with active MD may benefit from greater gains in SRS (23.5%, p = 0.0107). CONCLUSIONS CI provides greater gains in functional hearing for patients with MD compared with age-matched controls. Patients with active MD seem to perform better with respect to SRS following CI than patients with inactive status.
Collapse
|
11
|
Villavisanis DF, Mavrommatis MA, Berson ER, Bellaire CP, Rutland JW, Fan CJ, Wanna GB, Cosetti MK. Cochlear Implantation in Meniere's Disease: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 131:1845-1854. [PMID: 33464598 DOI: 10.1002/lary.29393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS Meniere's disease (MD) is a debilitating condition characterized by hearing loss, vertigo, and tinnitus. The objective of this study was to systematically investigate outcomes in MD after cochlear implantation (CoI), with and without labyrinthectomy. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of articles in Medline and Embase was performed to identify all studies of patients with MD who underwent CoI. This analysis evaluates outcomes of speech recognition, pure tone audiometry, vertigo, tinnitus, and quality of life. RESULTS Of 321 studies identified, 37 were included, involving 216 patients. Mean age at implantation was 61.4 years (range 27-85 years) with average length of follow-up at 1.7 years (range 0-9 years). Forty-four (20.4%) patients underwent labyrinthectomy. Meta-analysis demonstrated significant improvements in audiometric outcomes following CoI. There was a statistically significant improvement in Hearing in Noise Test performance, with a mean difference improvement of 44.7 (95% confidence interval [CI] [8.8, 80.6]) at 6 months and 60.1 (95% CI [35.3, 85.0]) at 12 months. The Freiburger Monosyllabic Test (FMT) and Consonant-Nucleus-Consonant (CNC) also improved significantly, with mean difference improvements of 46.2 (95% CI [30.0, 62.4]) for FMT and 19.3 (95% CI [8.1, 30.4]) for CNC. There was a statistically significant decrease in tinnitus, as measured by a mean difference reduction of 48.1 (95% CI [1.0, 95.2]) in the Tinnitus Handicap Index. CONCLUSIONS CoI with and without simultaneous labyrinthectomy is a viable treatment option for patients with MD, yielding high rates of tinnitus suppression and vertigo control. Post-CoI MD patients demonstrate similar postoperative speech perception outcomes to non-MD implant recipients. Laryngoscope, 131:1845-1854, 2021.
Collapse
Affiliation(s)
- Dillan F Villavisanis
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Maria A Mavrommatis
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Elisa R Berson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Christopher P Bellaire
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Caleb J Fan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| |
Collapse
|
12
|
Varadarajan VV, Sydlowski SA, Li MM, Anne S, Adunka OF. Evolving Criteria for Adult and Pediatric Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2020; 100:31-37. [PMID: 32804575 DOI: 10.1177/0145561320947258] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The indications for cochlear implantation have gradually expanded as advancements in technology have evolved, resulting in improved audiologic outcomes for both adult and children. There remains a significant underutilization of cochlear implant technology in the United States, and recognition of the potential benefits of cochlear implantation for non-traditional indications is critical for encouraging the evolution of candidacy criteria. Adult cochlear implantation candidacy has progressed from patients with bilateral profound sensorineural hearing loss (SNHL) to include patients with greater degrees of residual hearing, single-sided deafness and asymmetric hearing, and atypical etiologies of hearing loss (eg, vestibular schwannoma, Ménière's disease, and otosclerosis). Indications for pediatric cochlear implantation have similarly evolved from children with bilateral severe to profound SNHL to implanting children at a younger age, including those with residual hearing, asymmetric hearing loss, inner ear malformations, as well as cochlear nerve deficiency. In this editorial, the literature investigating cochlear implantation for nontraditional indications is reviewed with an aim to use the best available evidence to encourage the evolution of candidacy criteria.
Collapse
Affiliation(s)
- Varun V Varadarajan
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | | | - Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | - Samantha Anne
- Head and Neck Institute, 443553Cleveland Clinic, Cleveland, OH, USA
| | - Oliver F Adunka
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| |
Collapse
|
13
|
Fluctuations in Vestibular Afferent Excitability in Menière's Disease. Otol Neurotol 2020; 41:810-816. [PMID: 32229758 DOI: 10.1097/mao.0000000000002634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if Menière's disease is associated with fluctuations in afferent excitability in four human subjects previously implanted with vestibular stimulators. STUDY DESIGN Longitudinal repeated measures. SETTING Tertiary referral center, human vestibular research laboratory. PATIENTS Four human subjects with previously uncontrolled Menière's disease unilaterally implanted in each semicircular canal with a vestibular stimulator. One subject had only two canals implanted. INTERVENTION(S) Repeated measures of electrically-evoked slow phase eye velocity and vestibular electrically-evoked compound action potentials (vECAP) over 2 to 4 years. MAIN OUTCOME MEASURE(S) Slow phase eye velocity and N1-P1 vECAP amplitudes as a function of time. RESULTS There were statistically significant fluctuations in electrically evoked slow phase eye velocity over time in at least one semicircular canal of each subject. vECAP N1-P1 amplitudes measured at similar time intervals and stimulus intensities seem to show somewhat correlated fluctuations. One of the subjects had a single Menière's attack during this time period. The others did not. CONCLUSIONS In these four subjects originally diagnosed with Menière's disease, there was fluctuating electrical excitability of the ampullar nerve of at least one canal in each subject. These fluctuations occurred without active symptoms of Menière's disease.
Collapse
|
14
|
Impact of Underlying Diagnosis on Speech and Quality of Life Outcomes After Cochlear Implantation for Single-Sided Deafness. Otol Neurotol 2020; 41:e432-e440. [PMID: 32176127 DOI: 10.1097/mao.0000000000002578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to compare outcomes in speech and quality of life in those undergoing cochlear implantation for single-sided deafness (SSD), with the aim to characterize the clinical impact of underlying diagnosis in the affected ear and pre-operative hearing status. STUDY DESIGN Prospective case series. SETTING Academic Cochlear Implant Center. PATIENTS 42 adult patients implanted with the diagnosis of SSD. INTERVENTIONS Patients were evaluated at 3-, 6-, and 12-months post-operatively using AZBio sentence and speech, and consonant-nucleus-consonant (CNC) depending on appropriate testing level. Our previously validated Comprehensive Cochlear Implant Quality of Life (CCIQ) questionnaire was administered. MAIN OUTCOME MEASURES Speech perception, quality of life. RESULTS Subjects were stratified by the underlying diagnosis: Meniere's Disease (MD; n = 10), sudden sensorineural hearing loss (SSNHL; n = 13), and Other (eg TBI, acoustic neuroma, progressive, noise-induced; n = 19). Mean preoperative PTA of the implanted ear was 82dB ± 17; that of the nonimplanted ear was 32dB ± 17. SSNHL and MD demonstrated the highest speech perception score at 3 months (93 and 95%), and "Other" demonstrated the lowest scores at 88%. All 3 groups demonstrated nadir in speech scores at 6 months before improving at 12 months, but the "Other" diagnoses maintained the lowest speech testing across all time points. All 3 groups reported improved quality of life on CCIQ. CONCLUSIONS Subjects with SSNHL and MD demonstrate excellent speech perception and quality of life outcomes after cochlear implantation for SSD. Subjects with "Other" diagnoses underlying their SSD demonstrated lower scores on speech testing but nonetheless reported improved quality of life.
Collapse
|
15
|
Berardino FD, Conte G, Turati F, Ferraroni M, Zanetti D. Cochlear implantation in Ménière's disease: a systematic review of literature and pooled analysis. Int J Audiol 2020; 59:406-415. [PMID: 32027195 DOI: 10.1080/14992027.2020.1720922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this study was to evaluate the effect of cochlear implantation (CI) in advanced Ménière's disease (MD).Design: The initial search on PubMed, EMBASE, and Cochrane databases yielded 171 articles; no language restriction was applied.Study sample: A total of 11 articles met the inclusion criteria and were included in this systematic review. Six articles provided patient-level data on improvement in speech recognition testing after CI.Results: The methodological quality of included studies was assessed by examining the study design, level of evidence, method of measurement and adequacy of outcome reporting. A random-effect model was fitted for calculating weighted means. Post-operative improvement in word recognition score (WCS) was 50.8% (95% confidence interval: 34.6-67.1%); general improvement of vestibular symptoms after CI was found in 67% of the pooled patients; when reported in the studies, quality of life (QoL) and tinnitus were also generally improved after CI.Conclusions: CI in advanced MD is a valid option providing good outcomes in terms of speech performances, regardless of the disease duration, uni- or bilaterality, age at implantation, previous therapeutic procedures and stage of activity of MD.
Collapse
Affiliation(s)
- Federica Di Berardino
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Specialist Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Giorgio Conte
- Department of Neuroradiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Federica Turati
- Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Ferraroni
- Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Specialist Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| |
Collapse
|
16
|
Masood MM, Farquhar DR, Brown KD, Pillsbury HC, King ER, O'Connell BP. Hearing Preservation and Speech Outcomes After Cochlear Implantation in Meniere's Disease. Laryngoscope 2019; 130:2874-2878. [PMID: 31821566 DOI: 10.1002/lary.28470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate speech perception outcomes and hearing preservation after cochlear implantation in patients with Meniere's disease (MD). STUDY DESIGN Retrospective chart review. METHODS Fifty-one adult patients, accounting for a total of 63 implants, with MD treated at a tertiary care center were included in the study. Patients with unaided preoperative air-conduction thresholds ≤80 dB at 250 Hz were included in hearing preservation analyses. The primary outcome measure was Consonant-Nucleus-Consonant (CNC) score. Hearing preservation was assessed as follows: 1) maintenance of functional hearing, defined as a postoperative unaided air-conduction threshold ≤80 dB at 250 Hz and 2) low-frequency pure-tone average (LFPTA) shift. RESULTS Speech perception scores improved significantly postimplantation; specifically, the CNC mean score was 9% preoperatively and increased to 57% by 1 year postoperatively (P < .001). Eighteen ears were included in hearing preservation analysis; the mean preoperative LFPTA was 65 dB (standard deviation [SD] = 10). The mean postoperative LFPTA at activation was 93 dB (SD = 21), and at 1 year was 102 dB (SD = 11). Twenty-seven percent of patients achieved short-term functional hearing preservation, whereas the longer-term outcomes were less favorable (11%). CONCLUSIONS Speech perception scores improve after implantation in patients with MD. Hearing preservation is possible in patients with MD, albeit at lower rates than reported non-MD populations. Our data suggest that there can be degradation in acoustic hearing over time. LEVEL OF EVIDENCE 4 Laryngoscope, 2019.
Collapse
Affiliation(s)
- Maheer M Masood
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.,Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Douglas R Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - English R King
- Department of Audiology, University of North Carolina Hospitals, University of North Carolina Health Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Favaretto N, Marioni G, Brotto D, Sorrentino F, Gheller F, Castiglione A, Montino S, Giacomelli L, Trevisi P, Martini A, Bovo R. Cochlear implant outcomes in the elderly: a uni- and multivariate analyses of prognostic factors. Eur Arch Otorhinolaryngol 2019; 276:3089-3094. [DOI: 10.1007/s00405-019-05613-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/21/2019] [Indexed: 12/01/2022]
|
18
|
Perkins E, Rooth M, Dillon M, Brown K. Simultaneous labyrinthectomy and cochlear implantation in unilateral meniere's disease. Laryngoscope Investig Otolaryngol 2018; 3:225-230. [PMID: 30062139 PMCID: PMC6057226 DOI: 10.1002/lio2.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/30/2018] [Indexed: 11/10/2022] Open
Abstract
Objective In a single‐institution, FDA‐approved IDE study, subjects with unilateral Meniere's disease and intractable vertigo underwent concurrent labyrinthectomy and cochlear implantation to determine speech perception, localization, and quality of life outcomes. Methods Three subjects with unilateral Meniere's disease with normal or near‐normal hearing in the contralateral ear underwent simultaneous labyrinthectomy and cochlear implantation. Sound localization, speech perception in noise and quiet, tinnitus handicap index, and quality of life measures were evaluated at 1, 3, and 6 months after implant activation. Results Sound localization testing demonstrated immediate benefit postimplantation with the cochlear implant (CI). RMS error with CI on was 22 degrees (±2) and with CI off was 63 (±15) at 6 months. Mean CI alone scores were 22% (±20) at 1 month and improved to 43% (±20) and 49% (±11) at the 3‐ and 6‐month intervals, respectively. AzBio sentences in babble (0 dB SNR) scores presented in the most challenging listening condition (S0NContra) were 28% (±20) at 1 month, 38% (±18) at 3 months, and 45% (±24) at 6 months. Tinnitus Handicap Inventory (THI) significantly improved from an average preoperative score of 42 (±26) to 0 at 6 months. Quality of life measures improved overall over the postimplantation follow‐up intervals. Conclusions Subjects with unilateral Meniere's Disease who underwent simultaneous labyrinthectomy and cochlear implantation experienced improvements in sound localization, speech understanding, tinnitus severity, and quality of life with device use. There was a trend for better performance over the postoperative intervals. Level of Evidence 2b.
Collapse
Affiliation(s)
- Elizabeth Perkins
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Meredith Rooth
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Margaret Dillon
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Kevin Brown
- Department of Otolaryngology-Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| |
Collapse
|
19
|
In vivo imaging of saccular hydrops in humans reflects sensorineural hearing loss rather than Meniere's disease symptoms. Eur Radiol 2018; 28:2916-2922. [PMID: 29564597 DOI: 10.1007/s00330-017-5260-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A case-controlled imaging study demonstrated that saccular hydrops was specific to Meniere's disease (MD), but only present in a subset of patients. Here, we compared patients with definite MD, vertigo and sensorineural hearing loss (SNHL) to elucidate the relationship between saccular hydrops and extent of SNHL. METHODS In this prospective study, we performed 3D-FLAIR sequences between 4.5 and 5.5 h after contrast media injection in patients with MD (n=20), SNHL (n=20), vertigo (n=20) and 30 healthy subjects. Two radiologists independently graded saccular hydrops. ROC analysis was performed to determine the hearing loss threshold to differentiate patients with saccular hydrops. RESULTS Saccular hydrops was found in 11 of 20 MD patients, 10 of 20 SNHL patients and in none of the vertigo patients and healthy subjects. In SNHL patients, 45 dB was the threshold above which there was a significant association with saccular hydrops, with sensitivity of 100 % and specificity of 90 %. In MD patients, 40 dB was the threshold above which there was a significant association with saccular hydrops, with sensitivity of 100 % and specificity of 44 %. CONCLUSIONS Our results indicate saccular hydrops as a feature of worse than moderate SNHL rather than MD itself. KEY POINTS • MRI helps clinicians to assess patients with isolated low-tone sensorineural hearing loss. • Saccular hydrops correlates with sensorineural hearing loss at levels above 40 dB. • Vertigo patients without sensorineural hearing loss do not have saccular hydrops. • Saccular hydrops is described in patients without clinical diagnosis of Meniere's disease.
Collapse
|
20
|
Hänsel T, Gauger U, Bernhard N, Behzadi N, Romo Ventura ME, Hofmann V, Olze H, Knopke S, Todt I, Coordes A. Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation. Laryngoscope 2018; 128:2110-2123. [PMID: 29314057 DOI: 10.1002/lary.27071] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates. DATA SOURCES We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE. REVIEW METHODS We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data. RESULTS We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing. CONCLUSION Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.
Collapse
Affiliation(s)
- Toni Hänsel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | | | - Nikolai Bernhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Nina Behzadi
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | | | - Veit Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Ingo Todt
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
21
|
Abstract
OBJECTIVE To investigate outcomes of cochlear implantation (CI) in patients with Ménière's disease (MD) with and without surgical labyrinthectomy. STUDY DESIGN Retrospective study. SETTING Multiple tertiary referral centers. SUBJECTS Thirty one ears from 27 patients (17 men, 10 women, aged 42-84) with CI in ipsilateral MD ear. INTERVENTION CI in ears with intact labyrinths (Group 1), CI with simultaneous surgical labyrinthectomy (Group 2), and CI sequential to surgical labyrinthectomy (Group 3). MAIN OUTCOME MEASURE Within-subject improvement on Bamford Kowal Bench test or City University of New York open set sentence tests. RESULTS Majority of ears achieved excellent open-set speech recognition by 12 months post-CI, irrespective of intervention group. Preoperative details including patient age and sex, implant, MD and previous intervention, and audiological test results did not significantly affect outcomes. Patients with MD undergoing CI only may experience vestibular dysfunction which may cause long-term concerns. Incidental finding was noted of eight ears with fluctuating symptoms in ipsilateral ear during 12-month period post-CI, with five of eight ears showing objective fluctuating impedances and mapping. CONCLUSION CI in MD can yield good hearing outcomes in all three groups and this is possible even after a long delay after labyrinthectomy. Bilateral MD patients are complex and prospective quality of life (QoL) measures would be beneficial in being better able to manage the vestibular outcomes as well as the audiological ones.
Collapse
|
22
|
MORENO-BRAVO A, SÁNCHEZ-GÓMEZ H, AGUILERA-AGUILERA GA, GONZÁLEZ-SÁNCHEZ M, SANTA CRUZ-RUIZ S, BATUECAS-CALETRÍO Á. Implante coclear en enfermedad de Ménière bilateral. Descripción de un caso. REVISTA ORL 2017. [DOI: 10.14201/orl201674.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
23
|
Cochlear implantation in patients with definite Meniere's disease. Eur Arch Otorhinolaryngol 2016; 274:751-756. [PMID: 27783138 DOI: 10.1007/s00405-016-4356-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
The exact pathomechanism of deafening in Meniere's disease (MD) is still unknown; intoxication of hair cells and neural damage from endolymphatic hydrops is discussed. In the literature, there are only a few reports on hearing outcome of MD patients after treatment with cochlear implantation (CI) whereby especially the comparison of MD vs. non-MD patients with CI differs. In this retrospective study, results in speech understanding [Freiburger Einsilber (FES65) and Hochmair-Schulz-Moser test in quiet (HSM) and in noise (HSM + 10 dB)] of 27 implanted MD patients were collected and compared to a matched standard CI cohort. Alternative diagnoses were excluded as far as possible by re-analyzing neuroradiologic imaging. After first fitting, MD patients showed significantly better results in FES and HSM testing compared to controls. At 1-year refitting, this effect could not be seen anymore. To conclude, cochlear implantation is a safe and effective treatment for deafness in MD patients. Results in speech understanding are at least equal compared to general CI recipients. To the best of our knowledge, this retrospective study examined the largest collective of CI users deafened by MD so far.
Collapse
|
24
|
|
25
|
Acupuncture Points Stimulation for Meniere's Disease/Syndrome: A Promising Therapeutic Approach. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6404197. [PMID: 27547229 PMCID: PMC4980515 DOI: 10.1155/2016/6404197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/22/2016] [Accepted: 06/05/2016] [Indexed: 12/28/2022]
Abstract
Objective. This study aims to explore evidence for acupuncture points stimulation (APS) in treatment of Meniere's disease (MD). Method. A literature search was conducted in seven databases including EMBASE, Medline, Cochrane Library, Web of Science, CBM, CNKI, and WangFang database and the data analysis was performed by using the RevMan version 5.3. Results. 12 RCTs with 993 participants were acquired after the search. The quality of most eligible studies was very low which limited the value of the meta-analysis. Compared with western medicine comprehensive treatment (WMCT), the APS alone or in combination with WMCT had a significant positive effect in controlling vertigo; however, the result was negative in hearing improvement and DHI. No adverse events were reported in the studies. Conclusion. The APS might be a promising therapeutic approach for MD. However, the currently available evidence is insufficient to make a definitive conclusion for the poor quality of included studies. More high-quality researches with larger sample size are urgently needed to assess the effectiveness and safety.
Collapse
|
26
|
Brown DJ, Mukherjee P, Pastras CJ, Gibson WP, Curthoys IS. Sensitivity of the cochlear nerve to acoustic and electrical stimulation months after a vestibular labyrinthectomy in guinea pigs. Hear Res 2016; 335:18-24. [PMID: 26873525 DOI: 10.1016/j.heares.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
Single-sided deafness patients are now being considered candidates to receive a cochlear implant. With this, many people who have undergone a unilateral vestibular labyrinthectomy for the treatment of chronic vertigo are now being considered for cochlear implantation. There is still some concern regarding the potential efficacy of cochlear implants in these patients, where factors such as cochlear fibrosis or nerve degeneration following unilateral vestibular labyrinthectomy may preclude their use. Here, we have performed a unilateral vestibular labyrinthectomy in normally hearing guinea pigs, and allowed them to recover for either 6 weeks, or 10 months, before assessing morphological and functional changes related to cochlear implantation. Light sheet fluorescence microscopy was used to assess gross morphology throughout the entire ear. Whole nerve responses to acoustic, vibrational, or electrical stimuli were used as functional measures. Mild cellular infiltration was observed at 6 weeks, and to a lesser extent at 10 months after labyrinthectomy. Following labyrinthectomy, cochlear sensitivity to high-frequency acoustic tone-bursts was reduced by 16 ± 4 dB, vestibular sensitivity was almost entirely abolished, and electrical sensitivity was only mildly reduced. These results support recent clinical findings that patients who have received a vestibular labyrinthectomy may still benefit from a cochlear implant.
Collapse
Affiliation(s)
- D J Brown
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia.
| | - P Mukherjee
- Department of Otology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - C J Pastras
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia
| | - W P Gibson
- Department of Otology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - I S Curthoys
- Vestibular Research Laboratory, The University of Sydney, School of Psychology, Sydney, NSW, 2050, Australia
| |
Collapse
|
27
|
Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
Collapse
Affiliation(s)
- J M Espinosa-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - J A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Complejo Hospitalario Universitario de Granada, Granada, Spain.
| |
Collapse
|